For patients with type 1 diabetes complicated by end stage renal disease (ESRD), kidney transplantation prolongs life and frees the recipient from the substantial morbidities of dialysis. Transplantation of whole pancreas has emerged as an effective treatment modality for patients with diabetes mellitus, especially those with established end-stage renal disease. However, it is not clear that transplantation of the pancreas itself prolongs the life of the recipient. Living donor kidney transplant (LDKT) and simultaneous pancreas-kidney transplant (SPKT) provide distinct benefits over deceased donor kidney transplant (DDKT) alone. But, previous studies have not demonstrated that the SPKT approach prolongs life compared with LDKT. Patients who receive an LDKT can later opt for a pancreas after kidney transplant (PAKT) or an islet after kidney transplant (IAKT). Therefore, when a transplant doctor is counseling a patient with type 1 diabetes and ESRD and has a live donor, the decision about whether to proceed with an LDKT or to remain on the waiting list for an SPKT requires careful consideration. The aim of this review was to summarize the current status and outcomes of SPKT, LDKT, IAKT, and PAKT and their effects on survival of patients with type 1 diabetes and ESRD.